An overview of current Australian and International Guidelines on diabetic foot disease

December 1, 2015

This is the second article in the “DFA Guides You Through” series on Australian and International diabetic foot disease guidelines. You can find the first article here.

Both the Australian and the International Working Group on the Diabetic Foot (IWGDF) Guidelines on diabetic foot disease use clearly formulated recommendations based on well-defined grading systems and extensive systematic literature searches, resulting in two documents that can be directly compared. This article aims to present a general comparison between the two guidelines. A detailed comparison will be made in the following articles of this “DFA Guides You Through” series.

Let’s start with the titles. These are very similar, concentrating on the “prevention and management of foot problems/complications in diabetes”. The Australian version adds in the process of “identification”. This seemingly minor addition points to the first difference between the guidelines. Five of the seven research questions that form the basis for the literature review of the Australian guideline, concern themselves with identification or assessment, separated from treatment interventions. In contrast, identification and assessment are integral parts of the IWGDF chapters on (interventions for) prevention, peripheral artery disease and infection, but their literature searches are less extensive.

Another difference between the two guidelines is the absence of recommendations with regard to interventions for peripheral artery disease or infection in the Australian guideline. The IWGDF dedicates a chapter to each of these components of treatment of diabetic foot ulcers, whereas they were outside the scope of work carried out for the Australian guideline. For the Australian situation, a therapeutic guideline exists for antibiotic use, which can be applied to patients with diabetic foot disease. An international group is currently working on a vascular surgery guideline for the management of severe limb ischemia. However, with the multidisciplinary nature of diabetic foot disease, the specific focus of the IWGDF chapters on that population makes it a useful endeavour as an Australian clinician to familiarize with them.

The IWGDF calls their document “Guidance”, rather than “Guideline”, to underline that these documents are written for a general situation. As acknowledged in their summary guidance, principles in the IWGDF Guidance need to be adapted to local circumstances. Specific recommendations in the Australian guideline concerning the Indigenous population or rural and remote areas exemplify such “local translation”.

An overview of the contents and the number of recommendations of both guidelines is given in this table. A more detailed comparison of similarities and differences with regard to prevention and treatment will follow in the next articles in this “DFA Guides You Through” series.